Definition
Liver failure (hepatic failure, liver failure) is the maximum degree of liver insufficiency. This results in a partial loss of metabolic functions of the liver. In the worst case, all liver functions come to a standstill.
Terminal liver failure with loss of metabolic functions of the liver is a life-threatening situation that requires immediate therapy. The maximum form can result in a hepatic coma, which is caused by the accumulation of various metabolic products in the body. Liver failure, if it cannot be attributed to a cause (e.g. alcohol-toxic liver damage), is listed as a separate disease entity in the ICD:
- K72. 0: subacute or acute liver failure
- K72. 1: chronic liver failure without further specification of the cause
Causes
There are many diseases and substances that can cause liver failure. Some of them lead to chronic liver damage, others damage the liver acutely. There are diseases that damage the liver tissue as well as those that impede the blood flow to the liver.
Both processes lead to a destruction of the liver function and thus to a failure of the metabolic functions. It is very difficult to list all conceivable causes, so the relevant clinical pictures and substances should be mentioned here. Inflammatory liver diseases: One important cause is hepatotropic viruses, i.e. hepatitis B, hepatitis C and hepatitis D viruses.
These viruses lead to chronic hepatitis (inflammation of the liver) and thus to liver cirrhosis, which leads to liver failure. Other inflammatory liver diseases, which, however, make up only a small percentage of all patients with liver failure, are Toxic liver damage: The most common cause of liver cirrhosis, which can ultimately lead to liver failure, is chronic alcohol abuse. Other causes of toxic liver damage are Other causes:
- PBC (primary biliary cirrhosis)
- PSC (primary sclerosing cholagitis)
- Autoimmune hepatitis
- Parasitic infections: e.g.
leishmaniasis, malaria, bilharzia
- Non-alcoholic fatty liver
- Liver toxic chemicals: certain occupational groups are exposed to hazardous substances, e.g. various pesticides
- Drugs toxic to the liver: Especially cytostatic drugs such as methotrexate (see: Methotrexate side effects) can cause severe damage to the liver, but are usually necessary to fight other primary diseases such as cancer. Drugs such as paracetamol ® or macrolide antibiotics can also lead to acute liver failure, especially in the case of an overdose, which is usually due to suicidal intent. However, high doses are then necessary.
- Poisoning with the tuber leaf fungus: It contains toxins like the amatoxin and phallotoxin, which can be deadly even in small amounts.
In addition already a mushroom is sufficient with a medium-heavy person.
- Metabolic diseases: e.g. Wilson’s disease, hemochromatosis, a-1-antitrypsin deficiency or cystic fibrosis.
- Diseases of the vascular system of the liver or vascular anomalies: By obstructing the blood flow to the liver, the liver function can no longer be maintained, resulting in liver failure. These include the Budd-Chiari syndrome and cirrhosis cardiaque.
- Cancer of the liver or liver metastases
- Heart failure, especially if the right heart is affected, the pumping weakness can cause blood to back up into the liver, resulting in congested liver
Cancer of the liver is a possible cause of liver failure. Most malignant tumors of the liver are liver metastases of other primary tumors.
Patients with a so-called hepatocellular carcinoma often also have cirrhosis of the liver, which limits liver function and healthy residual tissue. Other types of cancer such as lymphomas, cholangiocellular carcinoma or metastases from tumors of other organs can also manifest themselves in the liver and destroy the liver tissue. The malignant cancer leads to destruction of the liver tissue and a deterioration in the blood supply to the liver cells.
Especially inside HCCs (hepatocellular carcinoma), necrosis areas occur due to reduced blood flow. The degenerated liver tissue no longer fulfils metabolic functions. Overall, the prognosis is rather poor, as advanced liver cirrhosis is often present, especially in HCC.The residual tissue that is still functional is therefore very small and not sufficient to maintain adequate function.
As a result, the therapeutic measures for advanced disease are very limited. Alcohol is probably the biggest risk factor for chronic liver disease and thus for liver failure. Especially in the industrialized nations, a massive alcohol abuse is a widespread problem.
In Germany, about 2.5 million alcoholics are in need of therapy. A chronic alcohol abuse leads to alcohol-toxic liver damage. The damage can be divided into three stages, the first two of which are potentially still reversible.
In the last stage, alcohol-induced cirrhosis of the liver, the damage is no longer reversible. Such advanced liver damage can lead to liver failure as mentioned above. If all conservative and interventional therapies fail, the only remaining option is liver transplantation as the ultima ratio.
The chronic alcohol abuse not only leads to direct damage to the liver tissue in the sense of liver cirrhosis but also carries the risk of degeneration of the liver cells, which can result in cancer of the liver. This can then also lead to liver failure. So there is an urgent duty to end the alcohol abuse!
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